Inflammation + Kik Alicha (Ethiopian Turmeric Stew)

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TOPIC


Learn the fundamentals of inflammation, including the scoop on curcumin capsules and daily turmeric intake. Vicariously visit Ethiopia with a recipe for Kik Alicha, a turmeric spiced split pea wat or stew.


Click here for a printable doc with information & no graphics.



OVERVIEW


Acute inflammation is part of both the body’s defense mechanism and healing process. 


Chronic inflammation is when the immune system goes into overdrive. Best practice is to make choices that manage or prevent chronic inflammation to avoid long-term internal damage (1).


TYPES OF INFLAMMATION

Acute inflammation is localized and lasts for a few hours or a few days. Examples include a sore throat from a cold, acute bronchitis, a sprained ankle, or an infected ingrown toenail (2).


Subacute inflammation is a transitional period that lasts 2-6 weeks (3).

 



Chronic inflammation, i.e. low grade inflammation, lasts a few months to years and has whole-body effects. Over time, chronic inflammation may start damaging healthy cells, tissues, and organs. As an analogy represented by the above graphic, chronic inflammation is like multiple arrows targeting healthy cells, tissues, and organs. Research shows that chronic inflammation is associated with heart disease, diabetes, Alzheimer’s disease and cancer, arthritis, and bowel diseases like Crohn's disease and ulcerative colitis. It is considered a chicken-egg scenario because it is not clear whether the inflammation causes or is a result of the diseases (4).




SYMPTOMS


Acute inflammation is noticeable. The five symptoms: pain, redness, loss of function, swelling, and heat. Pain is usually present. Pain results when a buildup of fluid leads to swelling, and the swollen tissues push against sensitive nerve endings. Other biochemical processes also occur that affect nerves and contribute to pain (5).


Chronic inflammation is silent. Symptoms include fatigue, body pain, depression or anxiety, gastrointestinal (GI) complications, weight change, & persistent infection (1).





TREATMENT


Methods for treating acute inflammation include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs), e.g. ibuprofen (Advil) or naproxen (Aleve); intended for short term use (1)
  • Curcumin supplements; comparable to NSAIDs at high doses, while safer for longer term use (1)
  • Temperature (i.e. hot & cold) therapy (6)


Curcumin supplements supply a concentrated amount of the compound, curcumin, that makes the spice, turmeric, anti-inflammatory. 


Curcumin is a polyphenol antioxidant, the reason for turmeric's yellow color, and often associated with curry.


Curcumin has been shown to block certain biological pathways leading to inflammation (7).



Curcumin supplement dosing recommendations can be drawn from 

2019 and 2021 studies that compared the effectiveness of treating an inflammatory condition with curcumin vs the NSAIDs diclofenac and paracetamol.  More research to better establish overall effectiveness and treatment protocols of curcumin is desired.



Sample sizes: (2019) 139 patients, (2021) 144 patients. Adequate sample sizes for now.

Dosing: 500 mg supplement two times a day (2021) and 500 mg supplement three times a day (2019) for total daily dose of 1,000-1,500 mg per day. 

Duration: 4 weeks (2019) and 6 weeks (2021). 

Side effects: NSAIDs can cause severe GI side effects when taken longer than intended use of 10 days. Curcumin is equally effective, but without side effects (8-9).






To choose a safe supplement, look for a symbol from a third-party testing group. These groups have their own safety standards. Supplements are NOT tested by the FDA.


1) NSF: a nonprofit organization that offers two types of certification: NSF Contents Certified and NSF Certified for Sport. 


2) U.S. Pharmacopeia (USP): a nonprofit organization that sets the most widely accepted standards for supplements and mandatory standards for pharmaceuticals.


3)ConsumerLab.com: a for-profit company that regularly tests and certifies supplements (10). 





The alternative to curcumin capsules is ground turmeric, available at grocery stores or online. The ground spice is less expensive, but difficult to tolerate in large quantities at one time. Many people find doses greater than 1/4 tsp unpalatable due to turmeric’s earthy, slightly bitter flavor, somewhat similar to sage. Once you are used to the flavor of turmeric, it can be enjoyable and will turn your food a lovely golden color.




For therapeutic dosing, take 1,000-1,500 mg curcumin per day for 4-6 weeks, established by the most current research available. 


The participants in the 2019 and 2020 research studies used curcumin capsules. Curcumin conversion to ground turmeric is: 150 mg curcumin (3%) = 1 teaspoon (tsp) or 5 grams (g) of ground turmeric (11). Note: 3 teaspoons (tsp) = 1 Tablespoon (Tbl).


For therapeutic ground turmeric dosing: 

1,000 mg curcumin = 7 tsp (35 g) turmeric 


1,500 mg curcumin = 10 tsp (50 g) turmeric  



COOKING TIP


Acclimate your taste buds to turmeric 1/4 tsp at a time, always mixing with liquid or food because it is a powder. Oftentimes 1-2 tsp of turmeric becomes tolerable and enjoyable to consume in one sitting. Add to foods with liquid or sauce such as oatmeal, tofu stir-fry, white bean soup, brown lentil soup, red lentil dal, pasta sauce, or cauliflower puree. 




Fortified ground turmeric is available and  more expensive than plain ground turmeric. Fortified turmeric is not equivalent to curcumin pills. The amount of curcumin in one serving of fortified turmeric can be equivalent to regular ground turmeric. For example, 1 Tbl of FeelGood fortified turmeric has 450 mg curcumin, which is the same amount in 1 Tbl of ground turmeric.





Regarding potential drug interactions, 

let your doctor know if you are taking therapeutic doses of curcumin pills or ground turmeric and are also taking:


1) Anti-coagulants (blood thinners) such as Coumadin or warfarin. Turmeric can enhance the effect of these medications.


2) Oral hypoglycemic (blood sugar lowering pills) diabetes medications such as Glipizide. More research is needed on turmeric’s ability to lower blood sugar (12-13).



 MANAGEMENT & PREVENTION 


To manage or prevent chronic inflammation, eat foods with a variety of spices. Spices are packed anti-inflammatory antioxidants. Indian cuisine includes a variety of spices used daily in significant quantities to flavor meals. Other cultures also use a variety of daily spices; however, India uses a couple spices of interest, turmeric and cinnamon, in significant volumes and has been studied more extensively to find associations with reduced incidence of chronic disease (14).

Average daily intake of turmeric in India: 1/2 tsp per day, 2–2.5 g of turmeric, 60–100 mg of curcumin (7).


Long term, high doses of ground turmeric have not been studied. The World Health Organization (WHO) has determined 1.4 mg ground turmeric per pound of body weight is an acceptable daily intake (15).




Consider taking one 500 mg curcumin capsule once a week if you think your fruit and vegetable intake is low. This recommendation is based on the 100 mg curcumin daily intake found in Indian dietary patterns.


Whole food sources of antioxidants are best; however, it can be difficult to consume 2 cups of fruit and 2 1/2 cups of vegetables every day per USDA guidelines. 




COOKING TIP


Improve curcumin absorption by cooking turmeric in oil because curcumin is fat soluble. Cooking turmeric in fat such as canola oil also reduces turmeric’s bitter flavor. Another option for improving absorption is pairing turmeric with high fat foods such as avocado or peanut butter (16).





Consuming black pepper (for its piperine) with turmeric (for its curcumin) will improve absorption. Studies have found that 1/20th of a tsp which is equal to a few shakes from a pepper shaker or a few grinds from a pepper grinder (17).




Possible causes of chronic inflammation:

  • Untreated causes of acute inflammation, like an infection or injury
  • Autoimmune disorder, e.g. Type 1 diabetes, IBD, Rheumatoid arthritis, which involves your immune system mistakenly attacking healthy tissue
  • Long-term exposure to irritants, like industrial chemicals or polluted air
  • Smoking
  • Obesity
  • Excessive alcohol intake
  • Chronic stress (1)


How is chronic inflammation treated?

  • Nonsteroidal anti-inflammatory drugs (NSAIDs), e.g. ibuprofen (Advil), naproxen (Aleve). Usually short-term pain treatment. Not intended for long term use. 
  • Coricosteroids. Not intended for long term use. 
  • Supplements, e.g. (ALA) and curcumin (turmeric compound).  More on curcumin supplementation later.
  • Lifestyle changes, e.g. losing weight, more minutes or higher intensity of physical activity, changing your diet (1).


Anti-inflammatory foods include many plant foods, high in antioxidants and polyphenols, are known to have anti-inflammatory properties. Two well-studied dietary patterns, the Mediterranean diet and the DASH diet, are associated with reduced markers of inflammation (18). Many cultures from around the world are vegetarian or include many plants or plant proteins, such as foods from Ethiopia. 


Pro-inflammatory foods to limit or avoid: foods made of refined carbohydrates, deep fried, or cured. When eaten regularly in amounts, or volumes, that replace other anti-inflammatory food, refined carbohydrates can be pro-inflammatory by changing the composition and metabolism of your intestinal bacteria, triggering an unwanted immune response. These foods can also contribute to overeating and weight gain; overweight/obesity is a pro-inflammatory state. The process of deep frying oxidizes fat particles and makes the food pro-inflammatory. The process of curing meats produces a compound called nitric oxide (NO), which is a free radical with toxic properties.

  • Refined carbohydrates, like soda, white bread, and pastries (19)
  • Deep-fried foods, like doughnuts and French fries (20)
  • Processed meats, like hot dogs and sausage (21)


References

  1. Bard, S. Understanding and Managing Chronic Inflammation. Healthline. https://www.healthline.com/health/chronic-inflammation#symptoms. 20 Aug 2021. Accessed 19 Oct 2021.
  2. Acute and chronic inflammation. CBHS Health. https://www.cbhs.com.au/mind-and-body/blog/acute-and-chronic-inflammation. 20 Mar 2020. Accessed 19 Oct 2021.
  3. Hannoodee, S. Nasuruddin  D. Acute Inflammatory Response. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK556083/. 26 Nov 2020. Accessed 19 Oct 2021.
  4. Understanding acute and chronic inflammation. https://www.health.harvard.edu/staying-healthy/understanding-acute-and-chronic-inflammation. 01 Apr 2020. Accessed 19 Oct 2021.
  5. Martinez, K. Types and symptoms. Medical News Today. https://www.medicalnewstoday.com/articles/248423. 13 April 2020. Accessed 19 Oct 2021.
  6. Marcin, J. Treating Pain with Heat and Cold. Healthline. https://www.healthline.com/health/chronic-pain/treating-pain-with-heat-and-cold#heat-therapy.  07 Mar 2019. Accessed 19 Oct 2021.
  7. Meixner, M. Turmeric Dosage: How Much Should You Take Per Day? Healthline. https://www.healthline.com/nutrition/turmeric-dosage. 11 Jun 2018. Accessed 19 Oct 2021.
  8. Shep, D., Khanwelkar, C., Gade, P. et al. Safety and efficacy of curcumin versus diclofenac in knee osteoarthritis: a randomized open-label parallel-arm study. Trials 20, 214 (2019). https://doi.org/10.1186/s13063-019-3327-2. Accessed 19 Oct 2021.
  9. Singhal, S., Hasan, N., Nirmal, K. et al. Bioavailable turmeric extract for knee osteoarthritis: a randomized, non-inferiority trial versus paracetamol. Trials 22, 105 (2021). https://doi.org/10.1186/s13063-021-05053-7. Accessed 19 Oct 2021.
  10. Loria, K. How to Choose Supplements Wisely. https://www.consumerreports.org/supplements/how-to-choose-supplements-wisely/. 30 Oct 2019. Accessed 19 Oct 2021.
  11. Cooperman, T. Turmeric and Curcumin Supplements and Spices Review. https://www.consumerlab.com/reviews/turmeric-curcumin-supplements-spice-review/turmeric/. 23 Aug 2021. Accessed 19 Oct 2021.
  12. Zhang DW, Fu M, Gao SH, Liu JL. Curcumin and diabetes: a systematic review. Evid Based Complement Alternat Med. 2013;2013:636053. doi:10.1155/2013/636053. Accessed 19 Oct 2021.
  13. Migala, J. Turmeric (Curcumin): A Complete Scientific Guide. https://www.everydayhealth.com/diet-nutrition/diet/turmeric-curcumin-benefits-side-effects-types-more/. 28 May 2020. Accessed 19 Oct 2021.
  14. Martins, I. Indian Spices and Biotherapeutics in Health and Chronic Disease. Scientific Research Publishing. https://www.scirp.org/pdf/Health_2018041014454715.pdf. 11 Apr 2018. Accessed 19 Oct 2021.
  15. Evaluations of the Joint FAO/WHO Expert Committee on Food Additives (JECFA). WHO. https://apps.who.int/food-additives-contaminants-jecfa-database/chemical.aspx?chemID=638. 2021. Accessed 19 Oct 2021.
  16. Goodson, A. Why Turmeric and Black Pepper Is a Powerful Combination. https://www.healthline.com/nutrition/turmeric-and-black-pepper. 04 Jul 2018. Accessed 19 Oct 2021.
  17. Chaiken, B. Using Black Pepper to Enhance the Anti-Inflammatory effects of Turmeric. https://www.umassmed.edu/nutrition/blog/blog-posts/2019/6/using-black-pepper-to-enhance-the-anti-inflammatory-effects-of-turmeric/. 28 Jun 2019. Accessed 19 Oct 2021.
  18. Tsigalou C, Konstantinidis T, Paraschaki A, Stavropoulou E, Voidarou C, Bezirtzoglou E. Mediterranean Diet as a Tool to Combat Inflammation and Chronic Diseases. An Overview. Biomedicines. 2020;8(7):201. Published 2020 Jul 8. doi:10.3390/biomedicines8070201
  19. Fajstova A, Galanova N, Coufal S, et al. Diet Rich in Simple Sugars Promotes Pro-Inflammatory Response via Gut Microbiota Alteration and TLR4 Signaling. Cells. 2020;9(12):2701. Published 2020 Dec 16. doi:10.3390/cells9122701
  20. Keewan E, Narasimhulu CA, Rohr M, Hamid S, Parthasarathy S. Are Fried Foods Unhealthy? The Dietary Peroxidized Fatty Acid, 13-HPODE, Induces Intestinal Inflammation In Vitro and In Vivo. Antioxidants (Basel). 2020 Sep 27;9(10):926. doi: 10.3390/antiox9100926. PMID: 32992618; PMCID: PMC7601460.
  21. Yang YC, Wang ZH, Yin MC. Content of nitric oxide and glycative compounds in cured meat products-Negative impact upon health. Biomedicine (Taipei). 2018;8(2):10. doi:10.1051/bmdcn/2018080210

 



Kik Alicha (Ethiopian Turmeric Stew)

Culture Background: Ethiopia's primary language is Amharic. Alicha or alich’a in Amharic means mild stew, and kək or kikki means split peas. Wot or wat also is a word for stew. Kik alicha is traditionally made with niter kibbeh (Ethiopian spiced clarified butter), however this recipe uses canola oil, which is more readily in the U.S. Many cultures have traditional split pea or lentil stews, such as split pea stews in Persia and Iran and dal in India.  Something unique to Ethiopian stews is the pairing with injera, a spongey-sour flatbread made from fermented teff flour.


INGREDIENTS


16 oz bag (2 cups) dried yellow split peas 
8 cups water
2 tsp salt
1/4 cup canola oil
12 oz or 1 medium yellow onion, finely chopped
(slice in food processor then chop by hand)
4 cloves garlic, minced (food processor)
2 Tbsp fresh ginger, minced (food processor)
2 tsp turmeric
1 tsp black pepper

DIRECTIONS
1. Place split peas in a medium saucepan. Add salt. Add 8 cups water (enough to cover with some extra) and bring to a boil. Reduce to a simmer with a few tiny bubbles, leave the lid ajar so not too much water evaporates, cook for 1 1/2-2 hours. Better to overcook rather than undercook. Stir and check that the bottom peas are not sticking halfway through and again 3/4 of the way through. Add water if needed. 
2. Meanwhile, in a large skillet, heat the oil over medium-high heat. Add the onions and cook for a few minutes, then reduce heat to low and cook 10 minutes until medium brown. 
3. Move onions to the side, increase the heat to medium high and add the garlic, ginger, and turmeric to oil, and cook for 1 to 2 minutes, until browned and fragrant. Stir into the onions. Scrape everything with a spatula into the saucepan with the split peas.
4. Cook everything in saucepan for 5-10 minutes to briefly meld flavors. Flavors will continue to meld overnight. 
5. Suggested serving size: 1 cup. Can be served as a side: 1/2 cup serving. Great with 2 sardines per serving (untraditional). Lunch idea: serve with side of crunchy vegetables and fresh fruit such as pear or apple with some walnuts. Dinner idea: serve with flatbread or rice, steamed cauliflower &/or wilted gingery greens. 6. Makes about 6 cups. Easy to freeze, thaw overnight, and reheat. 

Adapted from Spache the Spatula and 196 Flavors. 
 

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